The florida medicaid handbook for members of sunshine health tells you how our program works and what we offer. Sunshine health is contracted to provide specialized services and is also. Florida state dental plans medicare, medicaid, chip. It is free or low cost, and it is run by both the state and the federal government. Please upgrade your browser to improve your experience english. If that sounds like the information youre looking for, visit. Provider directories florida medicaid sunshine health. Sunshine health plan speci c information 01022018 page 1 of 9 ata fl can receive an authorization request via facsimile at 800 9802380. The allwell medicare hmo plan gives you access to our network of highly skilled medical providers in your area. Sunshine health is a managed care plan with a florida medicaid contract. It also will offer access to a traditional medicaid managed care plan in nine of the 11 medicaid regions, after being shut out of regions 1 and 10. Sunshine health would offer medicaid beneficiaries access to a traditional plan as well as a. Head to our member and provider sections to find helpful information. At dentaquest, we are committed to improving oral health care for all.
Ncqa rated more than 1,300 health insurance plans based on clinical quality, member satisfaction and ncqa accreditation survey results. Coverage is open to lowincome people, families and children, pregnant women, senior citizens and people with disabilities. Florida inpatient medicaid prior authorization fax form. However, their mother may choose another plan for the baby after enrollment. Sunshine health plan speci c information 01022018 page 7 of 9 please refer to the health plan issued member id card to find copayment information or you may obtain the copayment information when verifying eligibility with sunshine health directly. For example, the child welfare specialty plan and the plan for children with. Flsunshine state health plan has a contract with medicare and medicaid to offer hmo snp plans. People on medicaid will get services using one or more of these plan types. Our health insurance programs are committed to transforming the health of the community one individual at a time. Childrens medical services managed care plan florida. Therefore, to ensure that part c remains the payer of last resort, the service provider must be enrolled in all of the medicaid mma plans for the uf nces area. There are three different programs that makeup the statewide medicaid managed care.
Florida names nine proposed medicaid health plans blogs. It is referred to as the statewide medicaid managed care smmc program. You can email your application and documents to the address listed on this page. The provider must be licensed within the state of florida and a member must be present and participating in the visit.
Ambetter from sunshine health makes it easier than ever to get health insurance coverage. We have programs, tools and supports to help you get healthy and stay healthy. Federal waiver approval and implementation floridas new medicaid plan called the managed medical assistance program will move nearly all of the states medicaid beneficiaries into managedcare plans. Sunshine health provides a comprehensive health plan offering, medicaid and longterm care coverage under one plan, across more regions of the state than any other managed care company in florida. Sunshine medicaid provider manual page 5 of documentation plan of care documentation.
Familyrelated medicaid fact sheet 3 coverage for children children under age 19 medicaid may be provided to children under age 19, who are unmarried, not legally emancipated, or whose marriage was annulled. Allwell from sunshine health is a new medicare advantage plan, providing quality healthcare youd expect from a big company, but delivered on a local level. We provide the integrated solutions you need to make it easier to deliver the best preventionfocused care for. In 2014, cms plan signed a contract with the florida agency for health. Centene shares your dedication to improving the health of our community. Eligible recipients who must enroll will have 30 days to choose a managed care plan from the plans available in their region.
What are the general medicaid requirements and what are the income requirements for medicaid in. Exceptions may apply for individuals who develop esrd while enrolled in an allwell commercial or group health plan, or a medicaid plan. The agency is committed to working with smmc plans to promote continuity of and better access to care for medicaid members. Pdf medicaid and comprehensive longterm care member handbook spanish pdf home newsroom about us contact us careers. Thank you for participating in our network of physicians, hospitals, and other healthcare professionals. Open the attached list and use the adobe acrobat search tool to locate specific drugs by name or hic3 therapeutic class. In florida, wellcare and sunshine health are bringing our health plans together to better serve our members, providers, partners and communities.
We do more than take care of our members when they are sick. We offer affordable medicare advantage plans in florida that includes the same benefits of original medicare plus extra benefits such as prescription drug coverage, vision, dental and hearing care. Staywell health plan is a managed care plan with a florida medicaid. Aarpmedicarecomplete choice plan 2 regional ppo united health care first coast advantage medicaid florida blue bcbs of florida see bcbs for determination humana ppo red stripe card only phcs. In 2011 the florida legislature established the florida medicaid program as a statewide, integrated. If a practitionerprovider already participates with sunshine health in the medicaid or a medicare product. Centene and its wholly owned health plans have a long and successful track record. Medicaid, chip and medicare, including prescription drug plans and health plans for families and children. Sunshine health will cover services provided via telemedicine to the same extent that sunshine health covers the same services in person. Eligible medicaid recipients will receive a letter with enrollment information, including information on how to enroll. This statewide medicaid managed care health plan implements a traumainformed model of care that uniquely integrates physical health, behavioral health, and child welfare in order to support the specialized needs of the children served.
The website contains our electronic billing manual, which offers detailed. Sunshine health has a child welfare specialty plan, called the child welfare. The institutional care program icp is a medicaid program that helps people in nursing facilities pay for the cost of their care plus provides general medical coverage. Sunshine healths medicaid child welfare speciality plan qpi.
Sunshine health is a managed care organization mco contracted. Shands healthcare is once again an innetwork medicaid provider. Medicaid, indicate the software vendors trading partner id. This profile reflects state managed care program information as of august 2014, and only includes information on active federal operating authorities, and as such, the program start date may not reflect the earliest date that a. The tampa companys staywell plan now has more than 600,000 florida medicaid members. You can look forward to choosing a primary care provider pcp to work with you and coordinate your care. A medicaid plan focused on you is a mission near and dear to our hearts. Floridas medicaid program is called the statewide medicaid managed care smmc. Florida provider resources florida medicaid sunshine. Please refer to the member id card for the phone number of sunshine s eligibility department. Authorizing services sunshine health medicaid and child welfare initial authorization of postevaluation, subsequent visits. This new plan, approved in june 20, is the final chapter in a medicaid reform effort that is almost a decade old. Florida provider resources florida medicaid sunshine health. They are american eldercare, sunshine state health plan and unitedhealthcare of florida.
Florida community care health plan, covered services. Medicaid recipients who qualify and become enrolled in the florida mma. Some providers may not perform certain services based on religious or moral beliefs. Staywell, a wellcare company, isnt affiliated with us but they provide information to those looking for florida medicaid solutions. Coming in second is sunshine health plan, a subsidiary of st. If the agencys decision stands, sunshine health plan will operate in all 11 regions of the state. Florida medicaids health plan resources the agency is committed to working with smmc plans to promote continuity of and better access to care for medicaid members. Your florida medicaid plan has many benefits to help you make the most of your plan. Childrens medical services health plan provider manual effective april 22, 2019 page 5 of 121. Florida inpatient medicaid prior authorization fax form author. Most medicaid recipients must enroll in a health plan that was selected through a competitive procurement to participate in the smmc program. Learn more about what kinds of things medicaid covers. Atafl will not accept ranges from providers when indicating the following in the plan of care.
In 2014, the florida medicaid program implemented a new system through which medicaid enrollees receive services. A guide to the institutional care program medical assistance for low income individuals in or entering a nursing home what is institutional care program icp. Florida unitedhealthcare community plan medicaid mma. Evv and claims billing for floridas state medicaid managed care program. Medicaid provides free or lowcost health insurance to millions of americans. In fact, medicaid is a part of florida kidcare program. This profile reflects state managed care program information as of august. Starting on december 1, 2018, humana, staywell, and sunshine health the mcos will require providers to use hhaexchange to submit confirmed visits and bill directly to each mco through the free hhaexchange portal. This workshop will provide an overview of sunshine healths child welfare specialty plan. Medicaid is a public health insurance plan for lowincome or disabled people of any age. If you plan to use a billing agent clearinghouse to submit directly tofrom medicaid, indicate the billing agentclearinghouses trading partner id. Medicaid provides medical coverage to lowincome individuals and families. Statewide medicaid managed care smmc is the program where most medicaid recipients receive their medicaid services. Managed medical assistance mma title 19 provider manual.
You can mail completed application to florida kidcare, p. To better connect members to appropriate services, please click on each health plans link to find information on expanded benefits, discharge planning tools and other helpful. Lighthouse health plan, a medicaid plan created by the. The allwell medicare hmo plan gives you access to our network of highly skilled medical. Lighthouse health plan is a local, communitybased medicaid health plan created and run by doctors. The rewards program is one of your sunshine health plan benefits. The sunshine health provider directory is a list of physicians, hospitals and other healthcare providers that are available to you. If a practitionerprovider already participates with sunshine health in the medicaid or a medicare. Managed medical assistance mma program, longterm care ltc program, and dental program. Provider service network psn nicklaus childrens health system. Enhanced my health pays member rewards program helps ambetter from sunshine health members take charge of their health. This profile reflects state managed care program information as of august 2014, and only includes information on active federal operating authorities, and as such, the program start date may not reflect the earliest date that a program enrolled beneficiaries and provided services.
Sunshine health offers comprehensive medicaid, longterm. Are you looking for direction on medicaid in florida. Florida department of children and families access florida. Please view our listing on the left, or below, that covers forms, guidelines, helpful links, and. Medicaid services in florida are administered by the agency for health care administration.
What are the general medicaid requirements and what are the income requirements for medicaid in florida. Sunshine health offers affordable florida medicaid, medicare plans and our health insurance marketplace product, ambetter. Unitedhealthcare of florida, inc sunshine state health plan, inc ahf mco of. Florida state medicaid managed care health health plan. We focus on building strong, longterm partnerships with providersso you can depend on us now and in the. Ncqa health insurance plan ratings 20152016 summary report medicaid search for a health insurance plan by state, plan name or plan type private, medicaid, medicare. Your new health insurance offers comprehensive physical and behavioral healthcare.
Services must be a covered health plan benefit and medically necessary with prior. Lighthouse health plan, a medicaid plan created by the doctors you know and trust. Sign in with your florida medicaid account use new password if you recently completed a reset. Sunshine line provides doortodoor transportation and bus passes for elderly, lowincome, and people with disabilities who do not have or cannot afford their own transportation. Inpatient medicaid prior authorization fax form keywords. Florida managed medical assistance program the agency for required to enroll in an mma plan to receive florida medicaid covered services. This new plan, approved in june 20, is the final chapter in a. Wellcare s corporate office is located in tampa, florida.
Managed medical assistance, longterm care, and dental. Florida managed medical assistance program medicaid. Sunshine health plan speci c information 01022018 page 1 of 9 atafl can receive an authorization request via facsimile at 800 9802380. Children eligible for medicaid can also receive benefits under florida kidcare program. Ambetter from sunshine health operates under its legal entity, celtic. Use our online search tool to find a dentist near you. Florida provider request for reconsideration and claim. Florida state medicaid managed care provider information. Transportation is provided for medical and social service appointments, grocery trips, health and wellness, personal business and more. The same high quality, high touch healthcare you get from nicklaus childrens health system will be available to you. Based on the information provided, visits for medicaid and child welfare. Guaranteed renewable means that your plan will be renewed into the subsequent.
Were excited to bring our companies together, what it means for our employees, and. Enrollment in a sunshine state health plan depends on contract renewal. This includes, children living with nonrelatives or. Our customer service team is friendly and cares about our members. Wellcare, centene medicaid winners health news florida.
Provider request for reconsideration andclaim dispute form use this form as part of the ambetter from sunshine healthrequest for reconsideration and claim dispute process. You can look forward to choosing a primary care provider pcp to work. Eef therapy services will be authorized after submission of the patient intake form as described in this manual. The state and federal government share the cost of the medicaid program. If you do not provide the software vendors trading partner id, you will be required to test. Medicaid eligibility requirements are statespecific, so candidates must learn how to qualify for medicaid in florida if they plan to apply for governmentsponsored health coverage in the sunshine state. Sunshine health 1 international pkwy, 4th floor sunrise, fl 33323.
Healthy florida plan may expand medicaid in sunshine state. Implementation plan florida department of transportation. Florida names 9 medicaid health plans but challenges loom. Oct 30, 20 the medicaid caseloads in state fiscal year 20142015. Florida medicaid, medicaid insurance plans from humana. Ambetter from sunshine health 2020 evidence of coverage florida. In florida, most medicaid recipients are enrolled in the statewide medicaid managed care program. Sunshine health provides the tools and support you need to deliver the best quality of care. Medicaid eligibility in florida is determined either by the department of children and families dcf or. Its time to take control of your health and this is the place to start. Florida medicare advantage plans with part d prescription. American eldercare a littleknown delray beach firm that specializes in caring for seniors in independent living, assisted living and rehab centers, as well as in their homes is the only company that won. Centene and its wholly owned health plans have a long and successful track record o.
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